EP0726784B1

EP0726784B1 - Visually directed trocar

Info

Publication number: EP0726784B1
Application number: EP94901532A
Authority: EP
Inventors: Steven G. Kaali
Original assignee: Ethicon Endo Surgery Inc
Current assignee: Ethicon Endo Surgery Inc
Priority date: 1992-11-17
Filing date: 1993-11-16
Publication date: 2001-04-18
Anticipated expiration: 2013-11-16
Also published as: DE69330169T2; AU678794B2; US5551947A; EP0726784A1; CA2149128C; CA2149128A1; DE69330169D1; JPH08503401A; US5376076A; EP0726784A4; JP2659278B2; US5334150A; ES2155846T3; US5380291A; AU5608794A; WO1994011040A1

Abstract

A new and improved laparoscopic trocar (12) and sleeve assembly (11) in which the trocar (12) is provided with a transparent tip (22) and accommodates a light telescope for supplying a video console so that while the trocar (12) is being surgically inserted through the adbodimal wall and into the abdominal cavity, visualization on the video console will be possible to avoid injury to blood vessels in the abdominal cavity wall or injury to any of the internal organs located in the addominal cavity. Once clear visualization is established, conventional laparoscopic procedures can be carried out safely.

Description

TECHNICAL FIELD

This invention relates to the field of operative and diagnostic laparoscopic surgical procedures and in particular to a new and improved visually directed trocar laparoscopic instrument and method of use for conducting such procedures.

BACKGROUND OF INVENTION

Operative and diagnostic laparoscopy is the most commonly performed surgical procedure in the United States today. Therefore, any complication associated with this procedure poses a major public health concern.
Conventional known laparoscopic procedures usually are carried out as follows:
1. An instrument known as the Veress needle is blindly inserted through the navel into the abdominal cavity of a patient.
2. Carbon dioxide is delivered blindly through the Veress needle into the abdomen.
3. A laparoscopy trocar assembly comprised by a trocar and trocar sleeve is blindly inserted through the navel into and through the abdominal wall of the abdominal cavity.
4. The trocar is withdrawn from the trocar sleeve and a light telescope with light source placed in the sleeve thus making visualization of the interior of the cavity possible.
5. Once clear visualization is established a variety of surgical procedures can be carried out safely through the central opening in the trocar sleeve with remotely operable surgical instruments in a conventional known manner.
There are several reports in the medical literature that the first two steps of a laparoscopic procedure as outlined above can be omitted, and the laparoscopic trocar assembly directly be inserted blindly into the abdominal cavity. Results of these papers indicate that complications can still be expected since the entry through the abdominal cavity wall into the abdominal cavity remains blind.
EP-A-0484725 discloses an instrument for penetrating body tissue including a tip in the form of a hollow conical window provided at the distal end of a shaft. The shaft is disposed in a sleeve that has a thread formed on its outer surface and extending the full length of the sleeve. A ratchet is provided at a proximal end of the sleeve with hand toggles for rotating the sleeve. The hollow conical window is bonded to a steel adaptor member threaded into the distal end of the shaft, and an illumination unit and an optical member are glued or cemented into the steel adaptor member. An operator places the tip at a desired penetration point and turns the ratchet manually or with an electromotor to rotate the sleeve relative to the shaft to enable the instrument to penetrate and move into body tissue without the application of axial pressure by the operator.

SUMMARY OF INVENTION

It is therefore a primary purpose of this invention to make available a new and improved visually directed, laparoscopic instrument which allows the laparoscopic surgeon to enter the abdominal or other cavity of a patient under direct vision. This visually directed laparoscopic procedure will eliminate most if not all major and minor complications associated with the blind invasive surgical technique presently employed in laparoscopic procedures as described above.
According to the present invention, there is provided a surgical penetration device according to claim 1.
The light transmission and imaging means of the surgical penetration device projects light outwardly into an abdominal or other cavity of a patient, and receives back and directs light images into a suitable light image receptor of a conventional miniaturised light telescope designed for surgical purposes. Elements of the miniaturised light telescope together with essential power supply conductors energise the light source and light receptors such as a bundle of fibre optic light coupling elements for deriving and providing back light images usable for laparoscopic diagnostic procedures even while the trocar is being surgically inserted through the navel and is penetrating through the layers of skin and abdominal wall of a patient and on into the abdominal cavity.
In preferred embodiments of the invention, the laparoscopic instrument includes a hollow tubular trocar sleeve that surrounds and encloses the trocar for a substantial portion of its length to form a combined trocar and sleeve assembly. The trocar is slidable lengthwise relative to the trocar sleeve whereby the trocar can be removed after visually controlled physical placement of the trocar and sleeve assembly into the abdominal wall of a patient's abdominal cavity at a desired location and to a desired depth. The trocar then can be replaced with a somewhat large fiber optic light telescope and video imaging system, and other remotely manipulatable surgical instrument inserted through the central opening of the trocar sleeve in a conventional known manner.
The invention enables a new and improved laparoscopic procedure comprising mounting a miniaturized light telescope with light source together with suitable miniaturized power supply conductors, and fiber optic coupling and light receptor elements in the hollow trocar prior to starting the laparoscopic procedure. The light telescope then is energized from an electric power source and the output of the light receptors supplied to a video display. Following this setup, the tipped and lighted end of the trocar is placed at a point, such as the navel, on a patient's abdomen to be penetrated while observing such placement on the video display. The lighted trocar then is surgically inserted by being pressed slowly and carefully into and through the walls of the patient's abdomen while observing the progress of the trocar assembly as it travels into and through the wall of the abdominal or other cavity. During this process, the operator, by properly controlling orientation and progress of the trocar tip, can assure that the trocar does not penetrate into the abdominal cavity at a place or for a distance where it might injure any blood vessels within the abdominal cavity walls or internal organs within the abdominal cavity.

BRIEF DESCRIPTION OF DRAWINGS

These and other objects, features and many of the attendant advantages of this invention will be appreciated more readily as the same becomes better understood from a reading of the following detailed description, when considered in connection with the accompanying drawings, wherein like parts in each of the several figures are identified by the same reference characters, and wherein:
Figure 1 is a side elevational view of a known, combined trocar and sleeve assembly with trumpet valve and stopcock components constructed according to the prior art;
Figure 2 is a side elevational view of a known trocar sleeve having a different trumpet valve construction from the assembly shown in Figure 1 and built according to the prior art;
Figure 3 is a side elevational view of a known trocar design suitable for use with the sleeve shown in Figure 2 and built according to the prior art;
Figure 4 is a longitudinal sectional view of a new and improved trocar having a transparent tipped end constructed according to the invention;
Figure 5 is a longitudinal view of a hollow trocar sleeve suitable for use with the new and improved trocar shown in Figure 4;
Figure 6 is a longitudinal sectional view of a new and improved combined hollow trocar and sleeve assembly employing the elements of Figures 4 and 5, and constructed in accordance with the invention; and
Figure 7 is a longitudinal sectional view of an alternative form of a new and improved hollow trocar having extra exterior handles constructed according to the invention.

BEST MODE OF PRACTICING THE INVENTION

As noted earlier in the brief description of the drawings, Figures 1, 2 and 3 of the drawings illustrate a prior art, known trocar and sleeve assembly now being used by the medical profession in performing laparoscopic procedures such as laparoscopic cholecystectomies. Other similar laparoscopic procedures can be performed using the instrument. In these drawings, Figure 1 is an elevational side view of a known combined trocar and trocar sleeve assembly 11 comprised by an elongated, solid, stainless steel trocar 12, best seen in Figure 3, and a hollow, tubular trocar sleeve 15 shown in Figure 2. Trocar 12 includes a pointed tipped end 13, which may be either pyramidal or conical in configuration, and is sufficiently sharp to be able to penetrate and be physically pressed through the navel, layers of skin and abdominal walls of a patient in order to provide access to the interior of the abdominal cavity. Trocar 12 is a solid rod of appropriate diameter, for example of from 6 to 9 millimeters in diameter, and terminates in a push cap 14 that facilitates surgical insertion of the stiff elongated rod 12 into and through the navel of a patient by pushing on cap 14.
The trocar 12 is physically supported within the trocar sleeve 15 shown in Figure 2 of the drawings. Trocar sleeve 15 is a cylindrical hollow tube fabricated from biologically compatible material, such as stainless steel. Sleeve 15 has a central opening into which the trocar 12 fits in a relatively tight manner, but is sufficiently loose to allow trocar 12 to be slid lengthwise relative to the sleeve 15 and withdrawn. Trocar sleeve 15 in most applications also includes at least one trumpet valve 16 as shown in both Figures 1 and 2 as well as one or more insufflation stopcocks shown at 17 in Figure 2. These elements all are of known construction and operation and need not be described in detail with respect to the present invention. In use the assembled trocar and sleeve appear as shown at 11 in Figure 1 of the drawings.
As described earlier in the specification, conventional laparoscopic procedure is carried out by first blindly inserting a Veress (not shown) through the navel into the abdominal cavity of the patient. Carbon dioxide gas then is delivered blindly through the Veress needle into the abdomen in an effort to draw the skin of the abdomen on which the navel is disposed away from any organs resting internally within the abdominal cavity and to improve visualization within the cavity. It is at this point that the laparoscopic trocar and sleeve assembly 11 is blindly inserted through the navel into the abdominal cavity.
After insertion of the trocar and sleeve assembly 11, the trocar 12 is withdrawn from the trocar sleeve 15 leaving the sleeve with its appended elements such as the trumpet valve 16 and insufflation stopcock 17 extending into the abdominal cavity. A light telescope with a miniaturized light source of conventional commercially available construction is inserted through the central opening of the trocar sleeve 15 to establish visualization of the intra- abdominal organs. Once clear visualization is established, a variety of surgical procedures can be carried out safely through the use of remotely operable surgical instruments inserted into the interior of the abdominal cavity through the central passageway in the trocar sleeve 15 in a known manner. Upon completion of the procedures, all instruments including the light telescope are withdrawn along with the trocar sleeve and the opening through which they were inserted is sewn up.
It is believed apparent that the step of introducing the trocar and sleeve assembly into the abdominal cavity using conventional known techniques, is a blind procedure and frequently causes injury to blood vessels in the walls of the abdominal cavity and organs located within the abdominal cavity close to the point of entry.
In order to avoid possible injury to the blood vessels and/or internal organs, the present invention was devised and is illustrated in Figures 4, 5 and 6 of the drawings together with Figure 7 which shows an alternative construction of the trocar according to the invention.
Figure 4 is a longitudinal sectional view taken along the longitudinal axis of an elongated, cylindrically-shaped trocar having a hollow tubular body 21 fabricated from an inflexible material (such as stainless steel) that is compatible with human flesh. Trocar 21 has a tipped end 22 that is sufficiently sharp that it can be surgically inserted through layers of skin and human flesh by physically pressing on a push cap 23 secured to the opposite end of the trocar. Tipped end 22 is fabricated from light transparent material such as glass or a space-age plastic and is shaped to form a light transmission and imaging element for projecting light outwardly into an abdominal or other cavity of a patient and for directing light images received back onto a suitable light image receptor 24. Tipped end 22 also has a substantially solid piercing point, as shown in Figure 4, which can be of pyramidal or conical configuration.
Light image receptor 24 is part of a commercially available, miniaturized, medical light telescope for surgical use and is not part of this invention. Receptor 24 may comprise a plurality of light receiving input ends of a bundle of fiber optic light coupling elements (not shown) or alternatively a semiconductor light to electric signal transducer. Trocar 21 has a central opening 25 which is of sufficient diameter to accommodate passage of the elements of the miniaturized light telescope such as a light source 26 comprised by a bundle of fiber optic elements, a semiconductor laser or a light bulb together with essential power supply conductors and/or fiber optic light coupling elements (not shown). These elements serve to energize light source 26 and light receptors 24 (or transducers if required) together with fiber optical or electric signal coupling elements for deriving and supplying video signals to a video camera 27, comprising a part of the light telescope system. The video camera 27 excites a suitable video monitor (not shown) for producing video images usable for diagnostic and surgical purposes even while the trocar is being surgically inserted into and is penetrating the layers of skin on the navel prior to proceeding into the abdominal cavity.
Trocar 21 shown in Figure 4 is designed for use with a trocar sleeve 28 shown in Figure 5. Trocar sleeve 28 comprises an elongated hollow tubular body of stainless steel or other similar material having an open end through which the tipped transparent end 22 of trocar 21 projects and a rubber sealing cap 29 on the opposite end. Preferably a trumpet valve 16 and insufflation stopcock, such as 17 shown in Figure 2, are included on the hollow trocar sleeve 28. If desired, the trocar sleeve 15 shown in Figure 2 and trocar sleeve 28 in Figure 5 can be made to be interchangeable.
Trocar sleeve 28 is designed to physically surround and enclose trocar 21 for a substantial portion of its length to form a combined trocar and sleeve assembly shown in Figure 6 of the drawings.
The trocar 21 is slidable lengthwise relative to trocar sleeve 28 so that the trocar can be removed after visual surgical insertion of the trocar 21 and sleeve 28 assembly into the abdominal cavity of a patient at a desired location and to a desired depth. After removal of trocar 21, it is replaced with a suitable known fiber optic light source and video imaging system (not shown) and supplemented with other remotely manipulatable surgical instruments (not shown) which can be inserted through the central opening of the trocar sleeve 28 in a conventional, known manner.
Figure 7 illustrates an alternative design of the trocar 21 wherein suitable handles shown at 32 and 33 are provided on opposite sides of the elongated tubular body of the trocar 21 at the end opposite transparent tip end 22. In all other respects, the trocar of Figure 7 is similar to that described with relation to Figure 4. Surgical insertion of the trocar 21 of Figure 7 and trocar sleeve 28 in assembled relation as depicted by Figure 6, through the navel of a patient can be better accomplished and more easily guided using the handles 32 and 33 while visually observing the progress of the trocar through the layers of skin and abdominal walls of a patient. By observing the pre-imminent entry of the trocar assembly into the abdominal cavity under conditions where the position of blood vessels in the walls of the abdominal cavity and internal organs located within the abdominal cavity can be observed, prior to thrusting the trocar all the way into the cavity, injury to the blood vessels and internal organs can be avoided.
In conducting a laparoscopic procedure employing the novel, hollow, laparoscopic trocar 21 with a tipped end 22 fabricated from light transparent material shaped to form a light transmission and receiving element, the procedure is commenced by activating the miniaturized light telescope including the light source and suitable miniaturized light receptors, power supply conductors and fiber optic couplings provided in the assembled hollow trocar and sleeve, while using the trocar of either Figure 4 or Figure 7, prior to starting the procedure. After the light source is activated, any output from the light receptors 24 is supplied to a video display console (not shown) via video receiver 27. The tipped and lighted end of the trocar 21 then is placed at the point on the patient's abdomen (such as the navel) to be penetrated while observing such placement on the video display. The trocar and sleeve assembly then is pushed slowly into and through the layers of skin and support flesh of the patient's navel while observing the progress of the trocar assembly on the video display while it travels into and through the navel. During this process, the positioning of the trocar can be adjusted by the laparoscopic surgeon, if necessary, by manipulation of the push cap 23 and/or side handles 32 and 33, to assure that the trocar does not penetrate into the abdominal cavity at a place or for a distance where it might penetrate and injure blood vessels in the walls of the cavity or internal organs within the abdominal cavity.
In the above recited procedure, the combined assembly of trocar 21 and trocar sleeve 28 are inserted together with the light source and video display components of the miniaturized light telescope contained therein. After completing the visually directed insertion of the combined trocar and sleeve assembly as described above, the trocar 21 together with its light source and video display components is removed from sleeve 28 which remains implanted in the abdominal cavity. The trocar 21 then is replaced in implanted sleeve 28 with the fiber optic light source and video imaging system of the miniaturized light telescope along with any other assorted remotely manipulatable surgical instruments, as needed, which are inserted through the central opening in the trocar sleeve in a conventional known manner.

PRACTICAL APPLICABILITY

This invention provides to the medical profession a new laparoscopic instrument which allows the laparoscopic surgeon to enter the abdominal cavity of a patient under conditions where he can directly, visually follow the progress of the pointed tip of the instrument as it passes through the layers of skin and supporting walls of the abdominal cavity. Hence, prior to entering the abdominal cavity to any great depth, the surgeon can observe whether there are any blood vessels in the supporting walls or internal organs which would be punctured or otherwise damaged if the trocar is allowed to penetrate too deeply at a selected point. The new procedure and instrument will eliminate many major and minor complications associated with the prior known blind invasive laparoscopic surgical techniques employed to implant the laparoscopic trocar and sleeve assembly into the abdominal cavity.
Having described two embodiments of a new and improved laparoscopic instrument and procedure according to the invention, it is believed obvious that other modifications and variations of the invention will be suggested to those skilled in the art in the light of the above teachings. It is therefore to be understood that changes may be made in the particular embodiments of the invention described which are within the full intended scope of the invention as defined by the appended claims.

Claims

A surgical penetration device comprising:-

(a) an inflexible elongated member (21) having a first end;

(b) light transmission and imaging means (22) provided at the first end of said elongated member to project light and receive light images;

(c) said light transmission and imaging means being affixed to said first end of said inflexible elongated member and including a light transmission and imaging member (22) formed substantially of transparent material;

(d) said light transmission and imaging means including transparent piercing means (30) for piercing human flesh to permit surgical insertion of said light transmission and imaging member through human flesh into a body cavity;

characterised in that said elongated member has means (25) for containing a conventional lighting means and a conventional light image receiving means in the form of a conventional telescope to cooperate with said light transmission and imaging means, said containing means (25) being sized to permit detachable slidable insertion of the conventional telescope in the elongated member and slidable removal of the conventional telescope from the elongated member.
A surgical penetration device as claimed in claim 1, wherein said piercing means includes a sharp pointed tip (30) formed on said light transmission and imaging means.
A surgical penetration device as claimed in claim 1, wherein said elongated member (21) is hollow.
A surgical penetration device as claimed in claim 1, wherein said light transmission and imaging means (22) has a light transmissible tapered section and a light transmissible non-tapered section, a predetermined amount of said non-tapered section being recessed in the first end of said elongated member.
A surgical penetration device as claimed in claim 4, wherein the non-tapered section of said light transmission and imaging means (22) is substantially circular in cross section.
A surgical penetration device as claimed in claim 4, wherein the predetermined amount of said non-tapered section is integrally joined to said elongated member (21) at said first end of said elongated member.
A surgical penetration device as claimed in claim 1, wherein said light transmission and imaging member (22) is formed of glass.
A surgical penetration device as claimed in claim 1, wherein said light transmission and imaging member (22) is formed of plastic.
A surgical penetration device as claimed in claim 1, wherein said elongated member (21) has a second end opposite said first end, and handle means (23) are provided proximate said second end to facilitate manipulation of said elongated member.